How useful are YouTube videos of pacemaker implantation? An objective study to assess quality of information content

Abstract Background Permanent pacemakers (PPM) are a commonly performed, life-saving cardiac procedure. Patients often seek further information on medical interventions beyond traditional consultation spaces via the Internet, but such resources can contain varying amounts of procedure-critical information. This has not been previously assessed for PPM implantation. Objective To assess the level of patient-relevant information content in videos of PPM implantation on YouTube. Methods We performed searches on YouTube using the search terms "Pacemaker" and "PPM implantation". Both searches were performed twice for reproducibility. The first 100 results from each search were screened for inclusion. All English language videos covering transvenous pacemaker implantation were included. A list of key information criteria encompassing several domains (explanation of the procedure, indications, pre-operative considerations, operative details, post-operative care, risks of the procedure, aspects of daily life affected by PPM implantation, prognosis, and alternative treatment options) was generated from existing text resources, supplemented by expert opinion. Two authors (RDS, SR) independently assessed the videos for presence of the predefined information criteria. Results Of 196 unique results, 33 videos uploaded by 32 users met inclusion criteria (Figure 1). No single video contained all essential information criteria. The mean number of criteria covered in the videos was 8/32 (standard deviation 4.8), with a range of 0/32 to 17/32. Three criteria were not covered in any videos. Most videos discussed elements of the PPM implantation procedure, the components of a PPM, and the reasons for implantation. However, key aspects of pre-operative (need for pre-operative tests, medication management) and post-discharge (limiting arm movements on the side of implant, need to keep PPM identity card and contact details of department, driving restrictions, need for generator replacement and likely battery longevity) patient care were rarely discussed (Figure 2). There was also limited discussion of the potential risks of PPM implantation. Furthermore, three videos contained out-of-date information, giving explicit advice to avoid all magnetic resonance imaging. Conclusion Videos on YouTube on PPM implantation do not contain sufficient information to give patients sufficient overview of the procedure. In some cases, they contain out-of-date information that may adversely affect the decision to implant and deprive patients of important diagnostic tests. They lack key patient-centric information on the practicalities of care around the procedure, which is probably the information most relevant to and desired by patients. There is a need for a professionally regulated, exhaustive audio-visual resource for patients seeking further information on PPM implantation. Furthermore, there is a need for increased oversight of patient information material uploaded on the Internet.